PLACES. Brevet Colonel L. A. Edwards, Surgeon, U. S. A., chief medical officer of the Bureau of Refugees, Freedmen, and Abandoned Lands, has communicated the following facts with regard to cholera among the freedmen during the period embraced in this report: 179 cases of cholera were reported to him, among this class, of whom 97 died, or one to every 1.81 cases. The places at which cases are reported were, New Orleans, where the first case was reported July 10th; Algiers, where the first case was reported July 20th; Lauderdale, Mississippi, where the first case was reported July 16th; Vicksburg, Mississippi, where the first case was reported July 1st; and Louisville, Kentucky, where the first case was reported June 30th. The following table gives the number reported for each month: Cases of Cholera reported among the Freedmen during 1867. Cases. Deaths. Cases. Deaths. 2 23 NOTE.-One case was admitted to hospital, Louisville, Ky., June 30th, 1867, and died July 2d, 1867; date of attack not given. Cases. Deaths. Cases. 4 II.—YELLOW FEVER. On hearing of the outbreak of yellow fever last summer at Indianola, Galveston, and New Orleans, the Surgeon General instructed the Medical Director to require from each post at which it should appear an account of the epidemic, and a list of patients similar to that required for epidemic cholera by Circular No. 3, already referred to. These instructions were cheerfully complied with, and very complete information with regard to the circumstances attending the epidemic at every garrison in which it appeared was thus collected. Appendix II contains statistical tables presenting the facts for each post, and such extracts from official reports as appeared to possess practical value. The statistical tables (Appendix, pp. 71-80) present for each month, separately, the number of cases and deaths of yellow fever, typhoid fever, typho-malarial fever, remittent fever, intermittent fever, diarrhoeal diseases, and all other diseases, with a total for all diseases except yellow fever, and an aggregate; wounds, accidents, and injuries are not embraced. C Deaths. These tables were prepared from the monthly reports of sick and wounded; after which they were carefully compared with the lists of names furnished, every discrepancy being investigated and corrected, as was done in preparing the cholera tables. Some of the appended extracts from official reports give figures differing from the tables by one or two cases. The editor has not felt at liberty to change their text, but believes that in all such instances the corrected tables prepared under his supervision will be found to be accurate. The extracts from official reports are quite voluminous, (Appendix, pp. 81-156,) but, it is thought, will be found full of interest. From them the following brief history of the epidemic has been prepared. The more thoroughly the facts connected with the spread of yellow fever in the army during 1867 are known, the more strongly they appear to favor the theory of the exotic origin of epidemic yellow fever in the United States. year It is believed that a careful study of the documents here presented will satisfy the reader that the experience of the medical staff of the furnishes many last army facts favorable to the doctrine of the portability and transmissibility of the disease, and favorable, therefore, to the establishment of an efficient quarantine in the case of vessels or persons coming from infected places. In this the experience of last year agrees with the general tenor of the experience of the medical staff of the army during the late war. In addition to this important practical point, the events of last year will serve to direct the attention of medical men and commanding officers to the importance of promptly removing any command exposed to this pestilence to some healthy rural site; and this with every hope of avoiding the spread of the disorder to any serious extent, even if the removal has been delayed until cases have occurred among the men. These practical conclusions appear the more important because the ordinary hygienic precautions were not found so effectual against yellow fever as experience had shown them to be against cholera, and because therapeutic endeavors have proved comparatively fruitless. The reports indicate clearly two foreign sources from which the disease was imported into the United States last year-Vera Cruz, Mexico, and Havana, Cuba. From Mexico it was brought to Indianola, and thence to other points in Texas. At all other stations it seems to have been brought directly or indirectly from Havana; and it is worthy of remark that the cases here indicated as of Mexican origin were more fatal than those of Cuban origin, two out of every five cases of the former dying, while the mortality of the latter was but two out of seven. The ratio of deaths was 400 per thousand cases for the first of these groups, 284 per thousand for the second. From Indianola the pestilence was carried to Galveston, and from each of these points it spread towards the interior of the State, along the chief routes of travel, being carried from Indianola to Victoria and Goliad; from Galveston to Houston, Hempstead, Brenham, and Austin. At Ringgold Barracks and at Brownsville it was more directly of Mexican origin, as will be presently shown; and at Jefferson, Texas, in the northeastern portion of the State, where there were but two cases, one was a man who had just come up the Red river from New Orleans, the other was his attendant. The fever was first introduced at New Orleans from Havana. It spread from New Orleans to Ship island, to Baton Rouge, and to all the other places in Mississippi, Alabama, and Tennessee where cases are reported. At Key West and at Fort Jefferson, Tortugas, it was introduced directly from Havana. The following paragraphs present a sketch of the facts attending the appearance of the disease at each of these posts: In the latter part of the month of May, an infected schooner from Vera Cruz, Mexico, arrived at Indianola and landed bedding and other articles; four days afterwards, two of the workmen who handled these effects were taken sick with yellow fever; both died. The disease subsequently spread among the citizens; at first in the neighborhood of the wharf at which the schooner landed, afterwards extending from house to house up Main street. The company of troops on duty at the post was stationed to the southwest of the town, and escaped until the 16th of June, when two men who had been employed guarding quartermaster's property in the town were taken sick, and communicated the disease to the camp. During July other cases occurred, and the medical officer in charge, Acting Assistant Surgeon S. Santoire, recommended the removal of the command to Green Lake, twenty-two miles distant. This was done July 28th, leaving but a small detachment at Indianola, composed chiefly of men who had had the fever. Two cases occurred at Green Lake shortly after the detachment reached there, but none subsequently. Towards the close of October, a detachment of the 35th Infantry, who had broken up their camp at Victoria, Texas, on account of the prevalence of yellow fever, arrived at Indianola; their arrival was followed by four cases and one death. There were in all 29 cases and 14 deaths among the troops near Indianola.* The epidemic at Indianola was at first imagined to be bilious remittent fever, as has so often happened on the first appearance of epidemic yellow fever. The appearance of yellow fever at Indianola was speedily followed by its outbreak at Galveston. There was unobstructed, almost daily communication between the two places, and the Morgan line of steamships made regular trips between Indianola and New Orleans, always stopping at Galveston both going and returning. Brevet Major Samuel Adams, Assistant Surgeon, U. S. A., states, in a letter dated August 13th, (see Appendix, page 83,) that the first case of the fever which occurred at Galveston was brought from Indianola about June 26th, and died, two days afterwards, at one of the boarding-houses in the lower part of the city. He asserts that the introduction of the disease was the result of gross negligence on the part of the city authorities, who did not attempt to establish quarantine until after this fatal case had occurred. Brevet Major Cyrus Bacon, Assistant Surgeon, U. S. A., who arrived in Galveston September 17th, after the death of Dr. Adams, has contributed an interesting report of the epidemic at Galveston. In this paper he states, on the authority of a local physician, that a man from New Orleans had been admitted to the City hospital June 22d with yellow fever, and recovered. The details of the history of this case have not been communicated, and the well-known accuracy of Dr. Adams, who was on the spot at the time of the occurrence of these cases, leads the writer of this report to look upon his statement with regard to the first unmistakable case of yellow fever as being substantially correct. The Galveston and Texas Medical Journal of February, 1868, contains an excellent account of the epidemic in this city, by Dr. S. M. Welch, a resident of Galveston. The writer gives an account of the introduction of yellow fever, which perfectly agrees with the story of Dr. Adams, although he mentions the alleged case of June 22d, which he *The foot note to table I, Appendix, page 71, says, erroneously, "there were, besides, two cases in June.". It has since been observed that the July list of names duplicates these cases, so that the text above is accurate. admits would take precedence, "if there was no mistake as to its character." The first case among the troops at Galveston occurred July 1st; the disease subsequently steadily spread among them, and cases continued to occur during August, September, and October, the last case proving fatal November 1st. In all there were one hundred and ninety-nine cases, of whom seventy-nine died. Three medical officers perished at this post; there were, besides, five cases and two deaths in a small detachment of colored troops temporarily at the post. The total number of cases exceeds the mean strength of the command, which, of course, was much reduced by the number of deaths during August and September. The list of names, however, leaves no doubt that the number of cases is accurate, and that it does not include relapses or second attacks. The number of deaths among the citizens of Galveston is estimated by Dr. Bacon at 1,180; by Dr. Welch, in the article above referred to, at 1,150. From Indianola the pestilence was carried up the road towards San Antonio, to Lavacca, Victoria, and Goliad. There were no troops stationed at Lavacca, and no detailed account of the epidemic there has been received. At Victoria, cases appeared among the citizens during the month of August, but did not extend to the troops till a month later. During the latter portion of September and the early part of October there were eighteen cases and four deaths out of an average mean strength of 74 men. About the middle of October the post at Victoria was abandoned and the command removed to Indianola. From Victoria the fever was carried to Goliad, between which place and Victoria uninterrupted communication existed. Goliad is situated on high ground, with no swamps or stagnant water in the vicinity; it is noted for its health. There were twenty-five deaths among the citizens of this town. The troops, encamped only a quarter of a mile from town, were isolated by quarantine; only five cases are reported among them, all of whom recovered. These cases occurred during the month of October, the strength of the command being 43. Returning to Galveston, it will be found that the pestilence was carried thence towards the interior along the chief route of travel. During the third week of August it became epidemic among the citizens of Houston, cases having been brought the week before from Galveston. The first case among the troops occurred September 7th. The patient was a soldier on duty as a teamster, who visited the city daily. There were, in all, seventy-one cases and twenty-five deaths, out of an average strength, for the six months, of 72 officers and men. The last case appeared on the 3d of November. At Hempstead, the first case was a citizen named Vorhees, who arrived some time in August, and died shortly afterwards. This event was followed by the appearance of other cases among the citizens of the place. On the 6th of September one of the officers of the garrison was attacked, and towards the middle of the month cases began to occur among the enlisted men. In all fifty-five cases and twenty-nine deaths are reported out of an average strength of 110 officers and men. The last cases occurred early in December. At Brenham, some little distance beyond Hempstead, on the road to Austin, yellow fever was introduced from Galveston by an attaché of the Freedmen's Bureau, who arrived August 8th, and was taken sick next day. The disease subsequently spread among the citizens of Brenham, but the troops almost wholly escaped; only two cases were reported among them—the first, that of Lieutenant Lambert, who had just arrived from Houston, where he undoubtedly contracted the disease; the second, the man detailed to nurse him; both cases proved fatal. The troops were encamped in the town, and Acting Assistant Surgeon C. E. Warren on duty with them, attributes their escape to the use of white mustard seed as a prophylactic. He also denies that Lieutenant Lambert's attendant had the fever, but it is thought that the facts recorded in his letter of April 6, 1868, (see Appendix, page 96,) do not accord with this interpretation. At Austin, a short distance beyond Brenham, there were but two cases. The first occurred during September, and proved fatal; the patient was a prisoner just arrived from New Orleans, where the fever was prevailing. The second case occurred during November, and recovered; the patient was a soldier who came from Galveston a fortnight previously. Notwithstanding the introduction of these two cases, the disease did not, however, extend to the troops at Austin. At Brownsville, on the Rio Grande, yellow fever appeared among the citizens about the 1st of October. It is difficult to fix the precise date, as the earliest cases were not recognized. Assistant Surgeon E. Cowles, U. S. A., on duty at this post, recounts the efforts made to protect the place by quarantine, and states that he was unable to obtain any evidence of the importation of the disease. It appears from his own report, however, that the first cases known to him were Austrians recently belonging to Maximilian's army, and not long before arrived from Vera Cruz. The report of Dr. Francis Barnes (see Appendix, page 120) shows that a detachment of the same disbanded army, en route from Vera Cruz to New York, suffered from yellow fever on the way, and there appears to be little doubt that it was from this source the pestilence was introduced at Brownsville, the prevalence of yellow fever at Vera Cruz being well known. The troops stationed at Brownsville, averaging 76 white and 395 colored troops, were isolated, and intercourse with the citizens prohibited; as a result, no cases occurred among them. The four cases reported were officers who lived in the town, and came in contact with the disease there; all, fortunately, recovered. There were 130 cases of remittent fever reported among the men, but all recovered. At Ringgold Barracks, some distance further up the Rio Grande river, it is reported, by Acting Assistant Surgeon C. C. Furley, that no cases occurred among the colored troops stationed at that post. The average strength for the six months was 222 men. These troops were protected by a rigid quarantine from contact with the citizens in the vicinity, who suffered much from yellow fever. The fever was introduced among the citizens by an ambulance from Corpus Christi, which made a detour around the quarantine station and carried into Rio Grande City several fatal cases. As already stated, the colored troops escaped, but Dr. Furley, who had been exposed to several cases of the fever, especially to that of a quartermaster's employé named Forbes, was attacked September 30th; he recovered. On the 18th of November Acting Assistant Surgeon William Savage, who had just arrived from Brownsville, was attacked, and died on the 21st. These were the only cases at Ringgold Barracks among the officers, the men escaping, as before mentioned. The cases of Colonel Shafter and his attendant, mentioned by Dr. Furley, both of whom recovered, were, probably, not cases of yellow fever. Dr. Cowles, who was at the time the chief medical officer of the District of the Rio Grande, controverts several of Dr. Furley's statements, and doubts whether the disease at Rio Grande City was really yellow fever, and whether Dr. Furley's case was one of that |